PILATES FOR THE CLASSICAL PIANIST

Alyssa ForteComprehensive Apparatus Program

�1

October 2014 - February 2015Physio Logic, New York City

ABSTRACT

This study is focused on the prevention and rehabilitation of playing-related

musculoskeletal disorders for classical pianists by correcting muscular imbalances and

postural deviations through the assiduous employment of a specifically-tailored Pilates

program. The most common postural deviations among pianists are highlighted by

images of famous players like Bill Evans, as seen below. Postural deviations of these

pianists include kyphosis of the upper and mid-thoracic spine, forward head, and

excessive anterior displacement of the head of the humerus bone creating rounded,

forward, and elevated shoulders. These postural deviations may also be accompanied

by excessive posterior or anterior tilting of the pelvis. Over time, these poor habits will

contribute to major deterioration in the joints, as well as the onset of chronic injuries to

the upper extremity, such as tendonitis, carpal tunnel syndrome, arthritis, or repetitive

muscle strains, likely resulting in a shorter, more painful career.

�2

TABLE OF CONTENTS

TITLE PAGE, 1

ABSTRACT, 2

TABLE OF CONTENTS, 3

ANATOMICAL DESCRIPTION, 4-6

CASE STUDY, 7-16

BIBLIOGRAPHY, 17

�3

ANATOMICAL DESCRIPTION

First, it is crucial to define and understand what is required to exhibit “good

posture”, or what we refer to in the Pilates Method as neutral pelvis, neutral spine. The

above image, on the left, shows three common variations of deviations from the plumb

line. In the first image, labeled, A, the natural curves of the spine are present and the

key bony landmarks are vertically stacked. When observing the plumb line of a client,

check for these bony landmarks and notice if any fall forward or behind the imaginary

line. Then you will be able to procure information about what is tight, weak, lengthened,

or shortened. The bony landmarks that should all fall into one line for correct posture

from a lateral view are the middle of the lateral malleolus of the ankle bone, the side of

the knee joint, the greater trochanter at the hip joint, the middle of the lower ribs (or third

lumbar vertebra), the head of the humerus bone, and just behind the ear. It is also

important to note that postural deviations should be observed laterally, posteriorly, and

anteriorly in both the sagittal and coronal planes for a complete analysis.

�4

Kyphosis is an exaggerated curvature of the thoracic spine. Many pianists

develop kyphosis from the sedentary nature of practicing. Functional kyphosis is

extraordinarily common not only for pianists but for anyone who spends a number of

hours a day sitting with a slumped posture. The muscular imbalances that occur with

functional kyphosis are shortened and tight neck extensors and pectoralis major/minor,

coupled with stretched and weak upper back extensors and scapular depressors. The

upper fibers of the rectus abdominis may be tight, as well. The combination of the

muscular imbalances that contribute to postural kyphosis are identified as Upper Cross

Syndrome.

Fatigue posture, or “sway back”, is the

combination of kyphosis in the thoracic region and

anterior displacement of the pelvis, and is usually accompanied by genu recurvatum

(hyper-extended knees), forward head, and the ribcage shifted posteriorly. The name

fatigue posture alludes to the very minimal muscular activation required to maintain this

�5

upright position against gravity. The anterior displacement of the pelvis allows laxity in

the hip flexors and upper back extensors, and the person is able to “hang” on the

ligaments, particularly the iliofemoral ligament, also known as the Y ligament, to remain

upright.

�6

CASE STUDY

Evan Shinners is a classically trained concert pianist, alumni of the Juilliard

School of Music, and performing artist based in Brooklyn, New York. Evan is thirty

years old and has been playing the piano for twenty years. He approximates having

spent 15,000 hours of his life sitting at the piano. I met Evan in September of 2015 and

have been teaching him the philosophies of Pilates for exactly one year. When we met I

immediately noticed Evan’s slight kyphotic curve in his thoracic spine and how it was

exaggerated when he sat down at the piano bench. I had the advantage of observing

him both inside and outside of the studio, thusly I was able to observe and analyze his

day-to-day movement habits, as well as his mechanics while learning the BASI

repertoire.

Evan was diagnosed with tendonitis in his right hand in 2015, after suffering an

acute injury while playing the piano that he describes as, “it felt like the tendon popped

out of my hand, moved over to the adjacent metacarpal, and then went back into place”.

After this incident, Evan took a hiatus from playing for six weeks. According to William

J. Dawson, in his book, The Musician’s Guide to Playing Healthy, tendonitis is a

“catchall” term used to diagnose any number of chronic or acute playing-related overuse

injuries.

By the time I met Evan he was back to a regimented schedule of playing for five

hours a day, but was weary of the injury reoccurring and had expressed a desire to

improve his posture at the piano, and to be able to play for longer periods of time

without getting fatigued in the forearms and lower back. As a professional dancer, a

studied movement analyst, and a student of BASI Pilates, I knew this could be

�7

addressed and corrected, or, in the very least drastically improved through careful

instruction and the employment of the seven principles of BASI Pilates; awareness,

balance, breath, concentration, center, control, efficiency, flow, precision, and harmony.

My practical goals for Evan were to correct his fatigue posture, functional

kyphosis, winged scapulae, and rounded shoulders. My empirical goals for Evan were

to use the 10 Pilates principles to guide him to his own spiritual connection to healing

and wellness of body and mind through movement. The following pages outline our

structured progression through the BASI Pilates Block System. I had discussions with

Evan regarding how to practice lateral breathing and how to engage the Transverse

Abdominis for several hours prior to teaching him any of the following repertoire.

THE MAT WORK

THREE WEEKS ONLY MAT WORK, THREE TIMES PER WEEK.

BLOCK EXERCISES MUSCLE FOCUS CUEING AND NOTES

INTRODUCTION The Roll Down

First against a wall, then without.

Postural Analysis Cueing to find ease and articulation through each vertebrae. Observed tightness in the hamstrings and lower back, concurrent with fatigue posture. Observed tightness of subocciptical muscles and neck extensors.

�8

WARM UP Pelvic Curl, Spine Twist Supine, Chest Lift (plus rotation), Leg lifts/Changes, Rest Position

Abdominals, Hamstrings Cueing to find the deep hollowing of the low belly to initiate the movement or stabilization of the pelvis, and hip flexor disassociation. Stretching the low back extensors during Rest Position w/ emphasis on lateral breathing.

ABDOMINAL WORK Hundred Prep, Roll-up Abdominals Cueing to activate the TA (transverse abdominis) before any movement occurs, and to disassociate hip flexors. Careful watch and correction of head/neck alignment and scapular stabilization.

SPINAL ARTICULATION

Rolling, Spine Stretch Abdominals Cueing to maximize lumbar flexion, increase ROM during Spine Stretch, and scapular stabilization during Rolling. Extra emphasis on maintaining a neutral pelvis.

LATERAL FLEXION/ROTATION

Side Lifts Abdominal Obliques Tactile cueing for recruitment of the External Obliques, specifically, though only a few repetitions are possible - because low back extensors are tight and Transverse is slowly building strength. By week 3, we do a few repetitions of Side Lift.

BACK EXTENSION Back Extension Back Extensors Cueing to activate the TA (transverse abdominis) before any movement occurs, and to initiate the lift from the upper back rather that lower back. Careful watch and correction of head/neck alignment and scapular stabilization.

�9

After the first three weeks of mat work improvements are already visible in Evan’s

standing posture. The kyphotic curve in the thoracic spine has lessened and there is a

noticeable change in how he is mindful of the gentle hugging of the bellybutton towards

the spine during all movements. When Evan demonstrated the strength and

understanding of maintaining a neutral pelvis, I incorporated the spine corrector during

Chest Lifts, and Spine Twist Supine to give him a stretch of the upper abdominals, while

training them to activate through a full range of motion. Next, we progressed to

incorporate the Reformer, Cadillac, Ladder Barrel and Wunda Chair exercises. The

goals I had for Evan’s program were more specifically targeted to strengthening certain

muscles, while stretching others, for the correction of the following misalignments.

Winged Scapulae & Rounded Shoulders : STRETCH - Pectorals, STRENGTH -

Rhomboids, Serratus Anterior, Latissimus Dorsi, Posterior Deltoid.

Functional Kyphosis & Forward Head: STRETCH - Upper Rectus Abdominis, Pectorals,

Cervical Extensors, STRENGTH - Erector Spinae (spinalis, iliocostalis, longissumus),

Lower Trapezius, Rhomboids, Transverse Abdominis, and Lower Rectus Abdominis,

Cervical Flexors.

**Using the headrest UP during abdominal exercises to encourage length in the back of

the neck.

Anterior Pelvic Displacement: STRETCH - Hamstrings, Lumbar Extensors, STRENGTH

- Hip Flexors, Iliopsoas Major/Minor, Lower Abdominals, and External Obliques.

�10

APPARATUS WORK - TWO TIMES PER WEEK, CONSECUTIVELY FOR FIVE

MONTHS IN TOTAL.

Notes: This the list of exercises we progressed through starting by leaving out the Full

Body Integration, and Spinal Articulation exercises. I kept the 55 minute sessions very

simple, usually with only one or two exercises in each block. However, this chart

includes all the exercises Evan was introduced to over a span of five months doing

Pilates.

SESSIONS 1-10

BLOCK EXERCISES MUSCLE FOCUS CUEING AND NOTES

WARM UP Mat - Pelvic Curl, Spine Corrector - Chest Lift (plus rotation), Spine Twist Supine

Abdominals Cueing to maintain a neutral pelvis, keeping the ribs knitted together without jutting forward, and correct head alignment.

FOOT WORK Cadillac & Reformer - Parallel Heels, Parallel Toes, V Position Toes, Open V Heels, Open V Toes, Calf Raises, Single Leg Heel, Single Leg Toes

Hamstrings, Quadriceps Headrest up on the Reformer. Cueing for eccentric contraction (resisting the springs) on the reformer. Footwork on the Cadillac very beneficial for increasing his hamstring flexibility.

ABDOMINAL WORK Chair - Standing Pike, Standing Pike Reverse. Reformer - Tilt.

Abdominals, Abdominal Obliques

Standing Pike Reverse and Tilt prove to be very beneficial to the client because they improve abdominal control while demanding extension of Upper Thoracic spine.

�11

HIP WORK Cadillac - Supine Leg Series. Reformer - Frog, Circles,Down, Up, Openings, Extended Frog, Extended Frog Reverse.

Hip Adductors Cueing the coordination of stabilizing a neutral pelvis while mobilizing the hip joint. Imagery of head of femur bone gliding smoothly in the socket. I modify the exercises with an imprinted spine to allow him to experience greater ROM in the legs, then progress to neutral pelvis.

STRETCHES Reformer - Standing Lunge. Cadillac - Shoulder Stretch. Ladder Barrel - Gluteals, Hamstrings, Shoulder Stretch.

Hamstrings, Pectorals, Anterior Deltoid, Gluteals, Hip Flexors

For Standing Lunge - not emphasizing the Hip Flexor portion of the stretch since the client’s main imbalance is with Hamstring tightness.

ARM WORK Reformer - Arms Supine Series. Chair - Shrugs. Cadillac - Arms Standing Series. Cadillac - Sitting Side Prep.

Latissimus Dorsi, Triceps, Mid + Lower Trapezius

Focusing on scapular stabilization with decreased shoulder ROM, then moving onto greater ROM during Standing and Supine Series. Shrugs - tactile cueing to find initiation and sustained activation of lower trapezius, and scapular depression. Finding isolated movements of the scapulae while the trunk remains unaffected does not deviate laterally, or into flexion.

LEG WORK Chair - Leg Press Standing.

Hamstrings Using this exercise mostly to teach the client pelvic lumbar stabilization while standing on one leg. Emphasizing the engagement of the high hamstrings/low gluteals and drawing the abs inward throughout.

�12

PROGRESSIONS USED DURING SESSIONS BEYOND NUMBER 10 INCLUDE ALL

OF THE FOLLOWING CUES AND EXERCISES FROM THE FUNDAMENTAL

REPERTOIRE ABOVE, AND INCLUDE THE EXERCISES AND BLOCKS BELOW:

LATERAL FLEXION/ROTATION

Chair - Side Stretch, Kneeling Side Stretch

Abdominal Obliques Using a manual assist and tactile cueing in both of these exercises to give the client the sense of “lifting up and over” during side bending.

BACK EXTENSION Chair - Swan Basic. Reformer - Breaststroke Prep, with the variation including back extension.

Back Extensors Isolating and initiating the movement from the upper back extensors, keeping the pubic bone pressed into the chair, and cueing for slight tuck of the chin, to avoid any misalignment in cervical spine. For Breaststroke Prep, keeping the wrists firm and elbows out…building strength to have proper wrist alignment.

BLOCK EXERCISES MUSCLE FOCUS CUES AND NOTES

WARM UP Cadillac - Warm Up Series

Abdominals Articulation of the vertebrae, maintaining a deep scoop of the low belly, and proper head and shoulder alignement.

FOOT WORK Chair - All Foot Work exercises. Cadillac - Hip Opener

Hamstrings Cueing for maintaining the upright position and extension through the upper thoracic vertebrae, while stabilizing a neutral pelvis.

�13

ABDOMINAL WORK Reformer - Hundred Prep, Coordination, Flat Back, Double Leg, Double Leg with Rotation.

Abdominals, Obliques Cueing to find and maintain C curves and flexion in the whole spine, without excessive neck flexion and without posteriorly or anteriorly tipping the pelvis. Finding more height of shoulder blades coming off the mat through strength of the abdominals.

HIP WORK Cadillac - Single Leg Supine Series.

Hip Adductors Cueing the stabilization of the pelvis in a neutral position. Not hyperextending the knee by “pulling the kneecaps up” - engaging vastus medialis, quadriceps.

SPINAL ARTICULATION

Cadillac - Tower Prep Abdominals Maximizing lumbar flexion to prevent excessive compression on upper thoracic curve. Emphasizing the flow and continuous movement.

STRETCHES Reformer - Kneeling Lunge

Hamstrings, Hip Flexors Holding the hamstring stretch for minimum 20 seconds or 5 breath cycles.

ARM WORK Reformer - Shoulder Push, Shoulder Push Single Arm, Rowing Back 1 (for posterior deltoid). Chair - Triceps Prone, Triceps Press Sit

Latissimus Dorsi, Serratus Anterior, Posterior Deltoid, Triceps.

Wonderful exercise for Evan to practice shoulder control and scapular stabilization - upper back extensors are engaged throughout movement. Amazing postural corrective exercise.

FULL BODY INTEGRATION

Cadillac - Kneeling Cat Stretch. Reformer - Up Stretch 1, Elephant

Abdominals, Back Extensors

Adding the challenge of co-contracting the transverse and the back extensors. Strengthening the multifidus.

�14

CONCLUSION

Immediately I saw significant changes and improvements to Evan’s posture and

body awareness. I have stressed the importance of The Overload Principle, and how

we must continue to progress towards more advanced work in order to truly have a

LEG WORK Reformer - Single Leg Skating. Chair - Hip Opener.

Gluteus Minimus, Progressing to strength training for the hip abductors (gluteus minimus) to balance out previously made gains in hip flexors and gluteals during hip extension.

LATERAL FLEXION/ROTATION

Reformer - Side Over on Box, Mermaid

Abdominal Obliques, Cueing to stabilize the scapula with a deep hollowing of the low belly, emphasis of rotation initiated from the obliques and feeling the ribcage wrap around the spine, “like a barbershop pole”. For Side Over, moving between two panes of glass, avoiding chin jutting forward and taking a long oblique stretch at the end.

BACK EXTENSION Chair - Swan on Floor. Cadillac - Prone 1

Back Extensors Coordinating extension with stabilization in the shoulders, slight external rotation of humerus bone, and a long line of energy out through the top of the head. Abdominal engagement throughout, and a neutral pelvis with the pubic bone pressing gently into the mat.

�15

lasting effect, and, also, to maintain the strength and flexibility gains we’ve made so far.

Evan experienced less pain in his upper extremities, and lower spine during long hours

sitting at the piano. He tells me he used to practice for hours and perform with his legs

crossed, one knee leaning on the piano to support the weight of his body, with his entire

upper body hunched over the keys and his face only inches from his hands. Today he

practices with a mirror across the room in order to check on his posture while sitting at

the piano. Ideal alignment and a neutral spine decreased undue pressure on

intervertebral discs, and I believe this had a direct effect on lessening the pain Evan

experienced in his forearms and hands. More importantly, he learned functional

strength and is able to perform day-to-day activities with a greater sense of ease and

harmony.

�16

BIBILIOGRAPHY

Dawson, William J. Fit as a Fiddle: The Musician’s Guide to Playing Healthy.

Plymouth, United Kingdom: The National Association for Music Education, 2008.

Isacowitz, Rael, & Clippinger, Karen. Pilates Anatomy. Champaign, Illinois: Human

Kinetics, 2011.

Clippinger, Karen S. Dance Anatomy and Kinesiology. Champaign, Illinois: Human

Kinetics, 2007.

Revak, Joan M. “Incidence of Upper Extremity Discomfort Among Piano Students”.

The American Occupational Therapy Association, Inc. American Journal of

Occupational Therapy, 1989. Web. September 2016.

�17